Reimbursement

More and more, insurers are trying to help members get fit, slim down, and eat better. But for one of this century's most pernicious health problems, some find they need data-driven frameworks to target interventions and gauge their effectiveness.

The San Francisco Bay area is getting a new accountable care organization courtesy of the formation of a new company by two healthcare powerhouses in the region.

A new portrait of the uninsured and newly-insured is emerging, with a confluence of factors shaping who is and isn't enrolling in Medicaid or private plans.

Not only are older Americans living longer than in past generations, they also have multiple health problems. If Medicare Advantage plans focus on effective engagement strategies that address these issues, they can improve member satisfaction and outcomes, scores for which are weighted three times more heavily than operation measures.

Among the many challenges in year two of federal exchanges, the process of auto re-enrollment is bringing the potential of convenience and disruption, for both consumers and insurers.

As payers and employers put pressure on providers to assume more financial risk, providers are struggling to assess the impact of the risk they have already assumed.

Lawmakers, taxpayers and health organizations concerned about Medicare's sustainability can breathe a small sigh of relief, if not hold their breath.

Medicare's Hospital Insurance Trust Fund won't run out of money until 2030. That's four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act.

A Pennsylvania provider is suing a health insurance company for passing on its 2 percent reimbursement cut required by sequestration.

Insurers trying to ride the wave of private exchanges need to be careful not to get swept up or knocked overboard amid varying business models and high customer expectations.